Organization
THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Active
Organization
THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Active
Other names
CROASDAILE VILLAGE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN ERICKSON (ASSISTANT SECRETARY/CORP EXEC DIR)
(919) 384-3001
Entity
Organization
Contact information
Practice address
2600 CROASDAILE FARM PKWY, DURHAM, NC 27705
(919) 384-2571
(919) 384-2649
Mailing address
2600 CROASDAILE FARM PKWY, DURHAM, NC 27705-1331
(919) 384-2571
(919) 384-2649
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34D0973408
CLIA NUMBER
NC
Enumeration date
04/18/2007
Last updated
09/17/2018
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